Things We Do for No Reason: The Use of Thickened Liquids in Treating Hospitalized Adult Patients with Dysphagia

• Allow patients with dysphagia access to free water
• Initiate protocols to ensure adequate oral hygiene, patient and family education, and optimization of positioning strategies

Our patient is assessed with a bedside swallow evaluation and has issues with minor coughing. Despite this, he repeatedly requests access to free water, and these requests are upsetting to his family. The risks of potential aspiration are explained to him, and he and his family express understanding. He is given supervised access to water between meals and is encouraged to sit upright and brush his teeth prior to drinking. He continues to improve throughout the hospitalization and at the time of discharge, his sodium level is within normal limits and he is delighted to be drinking regular water.

Patients with dysphagia are often restricted to thickened liquids. This approach does alter the liquid flow throughout the oropharynx and minimal clinical evidence supports this practice as a method to reduce aspiration pneumonia. Given the potential harm and the reduced quality of life, we recommend against thickened liquids in this setting. Taken as a whole, available evidence suggests that protocols to facilitate safe access to water,¹ family information and education,¹³ and positioning techniques¹⁴ are safe, effective, and preferable to thickened liquids.^1,12

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Disclosures

The authors have nothing to disclose.